Assistência de enfermagem à saúde das populações indígenas: revisão de escopo / Nursing care for the health of indigenous populations: scoping review / Asistencia de enfermería para la salud de las poblaciones indígenas: una revisión de alcance

RESUMO Objetivo: identificar na literatura as ações de assistência de enfermagem à saúde das populações indígenas. Método: trata-se de uma revisão de escopo, cuja busca foi realizada no mês de setembro de 2022 nas seguintes bases de dados: Base de Dados de Enfermagem (BDENF), Catálogo de teses e dissertações da CAPES, Google Scholar, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) e Scientific Electronic Library Online (SCIELO). Os resultados foram avaliados por meio de sumarização dos artigos selecionados. Resultados: as principais ações dirigidas à população indígena foram: consultas de enfermagem e atividades de promoção e prevenção da saúde. A principal dificuldade encontrada em relação aos povos indígenas é a barreira linguística. Conclusão: a equipe de enfermagem encontra dificuldades, como: a difícil localização das aldeias; alta sobrecarga de trabalho em decorrência da falta de profissionais médicos; barreira linguística; e condições inadequadas.

ABSTRACT Objective: to identify in the literature the nursing care actions for the health of indigenous populations. Method: this is a scoping review, whose search was conducted in September 2022 in the following databases: Nursing Database (BDENF), CAPES Theses and Dissertations Catalog, Google Scholar, Latin American and Caribbean Literature on Health Sciences (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) and Scientific Electronic Library Online (SCIELO). The results were evaluated by summarizing the selected articles. Results: the main actions directed to the indigenous population were nursing consultations and health promotion and prevention activities. The main difficulty encountered in relation to indigenous peoples is the language barrier. Conclusion: the nursing team encounters difficulties, such as: the difficult location of the villages; high work overload due to the lack of medical professionals; language barrier; and inadequate conditions.

RESUMEN Objetivo: identificar en la literatura las acciones de cuidados de enfermería para la salud de las poblaciones indígenas. Método: se trata de una revisión de alcance, cuya búsqueda fue realizada en septiembre de 2022 en las siguientes bases de datos: Base de Datos de Enfermería (BDENF), Catálogo de Tesis y Disertaciones de la CAPES, Google Scholar, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) y Scientific Electronic Library Online (SCIELO). Los resultados se evaluaron resumiendo los artículos seleccionados. Resultados: las principales acciones dirigidas a la población indígena fueron: consultas de enfermería y actividades de promoción de la salud y prevención. La principal dificultad encontrada en relación a la población indígena es la barrera lingüística. Conclusión: el equipo de enfermería encuentra dificultades como: la difícil localización de las aldeas; la elevada sobrecarga de trabajo debido a la falta de profesionales médicos; la barrera lingüística; y las condiciones inadecuadas.

FATORES INTERVENIENTES NO TEMPO DE INTERNAÇÃO HOSPITALAR DE PACIENTES COM COVID-19 / INTERVENING FACTORS IN THE LENGTH OF HOSPITAL STAY OF PATIENTS WITH COVID-19 / FACTORES QUE INTERVIENEN EN LA DURACIÓN DE LA ESTANCIA HOSPITALARIA DE LOS PACIENTES CON COVID-19

Objetivo: Analisar os fatores intervenientes no tempo de internação hospitalar de pacientes com COVID-19 internados em unidade de terapia intensiva. Método: Estudo transversal, de abordagem quantitativa, realizado com 119 pacientes internados em uma Unidade de Terapia Intensiva COVID-19 de um hospital público do nordeste brasileiro. Foram coletados dados sociodemográficos e clínicos e sua associação com o tempo de internação hospitalar foi testada pelo qui-quadrado de Pearson (p<0,05). A força dessa associação foi testada pela razão de chance, sendo a regressão logística (método backward) utilizada para ajuste do modelo. Resultados: A maioria (92,4%) dos participantes eram considerados do grupo de risco para a doença, sendo a Hipertensão Arterial Sistêmica (38,7%) e o Diabetes Mellitus (36,1%) as comorbidades mais prevalentes. Dos 119 pacientes internados, 75 (63%) permaneceram por até 10 dias. No modelo final da regressão, os pacientes do sexo masculino (p<0,001), em uso de cloroquina (p=0,013) e intubados (na admissão) permaneceram internados por tempo superior a 10 dias. Conclusões: No estudo, evidenciou-se, que o tempo de permanência hospitalar foi influenciado pelas variáveis sexo, tipo de tratamento utilizado e suporte de oxigenoterapia. Alguns pacientes, que já apresentavam comorbidades prévias, evoluíram para quadros graves da doença. No entanto, outros, conseguiram evoluir para cura. Conhecer esses fatores permite o aperfeiçoamento e a adequação das práticas assistenciais prestadas a esses pacientes, em especial nas estratégias que possam melhorar a qualidade do serviço e reduzir o tempo de internação. Palavras-chave: Coronavirus; Infecções por Coronavirus; Enfermagem; Tempo de Internação; Unidades de Terapia Intensiva

ABSTRACT Objective: To analyze the factors intervening in the length of hospital stay of patients with COVID-19 admitted to an intensive care unit. Method: A cross-sectional, quantitative study was conducted with 119 patients admitted to a COVID-19 Intensive Care Unit of a public hospital in northeastern Brazil. Sociodemographic and clinical data were collected and their association with length of hospital stay was tested by Pearson's chi-square (p<0.05). The strength of this association was tested by the odds ratio, and logistic regression (backward method) was used for model fitting. Results: The majority (92.4%) of participants were considered to be in the risk group for the disease, with Systemic Arterial Hypertension (38.7%) and Diabetes Mellitus (36.1%) being the most prevalent comorbidities. Of the 119 patients admitted, 75 (63%) stayed for up to 10 days. In the final regression model, male patients (p<0.001), using chloroquine (p=0.013) and intubated (at admission) remained hospitalized for longer than 10 days. Conclusions: The study showed that the length of hospital stay was influenced by the variables gender, type of treatment used and oxygen therapy support. Some patients, who already presented previous comorbidities, evolved to severe cases of the disease. However, others were able to progress to cure. Knowing these factors allows the improvement and adequacy of care practices provided to these patients, especially in strategies that can improve the quality of service and reduce the length of hospital stay. Keywords: Coronavirus; Coronavirus Infections; Nursing; Length of Stay; Intensive Care Units

Objetivo: Analizar los factores que intervienen en la duración de la estancia hospitalaria de pacientes con COVID-19 ingresados en una unidad de cuidados intensivos. Método: Se realizó un estudio cuantitativo transversal con 119 pacientes ingresados en una Unidad de Cuidados Intensivos de COVID-19 de un hospital público del nordeste de Brasil. Se recogieron datos sociodemográficos y clínicos y se comprobó su asociación con la duración de la estancia hospitalaria mediante el chicuadrado de Pearson (p<0,05). La fuerza de esta asociación se comprobó mediante la odds ratio, y se utilizó la regresión logística (método regresivo) para el ajuste del modelo. Resultados: La mayoría (92,4%) de los participantes fueron considerados del grupo de riesgo para la enfermedad, siendo la Hipertensión Arterial Sistémica (38,7%) y la Diabetes Mellitus (36,1%) las comorbilidades más prevalentes. De los 119 pacientes hospitalizados, 75 (63%) permanecieron hasta 10 días. En el modelo de regresión final, los pacientes varones (p<0,001), usuarios de cloroquina (p=0,013) e intubados (al ingreso) permanecieron hospitalizados más de 10 días. Conclusiones: En este estudio se evidenció que la duración de la estancia hospitalaria estuvo influenciada por las variables sexo, tipo de tratamiento utilizado y soporte oxigenoterápico. Algunos pacientes, que ya presentaban comorbilidades previas, evolucionaron a casos graves de la enfermedad. Sin embargo, otros consiguieron evolucionar hasta la curación. Conocer estos factores permite la mejora y adecuación de las prácticas asistenciales prestadas a estos pacientes, especialmente en estrategias que puedan mejorar la calidad del servicio y reducir la duración de la estancia hospitalaria

O cuidar e seus impactos negativos para cuidador familiar de pessoa com Alzheimer / Treatment and its negative effects for Alzheimer's family caregivers

O presente estudo objetivou investigar os impactos que o cuidado a um indivíduo com Alzheimer pode gerar ao cuidador familiar, assim como, possíveis alternativas desenvolvidas por este, para lidar com as adversidades. Realizou-se uma revisão integrativa nas bases de dados BVS Saúde e SciELO, com os descritores ‘Cuidado’, ‘Cuidador’, ‘Alzheimer’. Selecionou-se estudos disponíveis na íntegra, acesso gratuito, dentre os anos de 2015 a 2020, escritos em português, inglês e espanhol. Os resultados encontrados apontam para a existência de ônus físico, psicológico, social e financeiro ao cuidador. O perfil comum do cuidador é de mulheres, filhas ou esposas do enfermo, que assistem ao doente de forma solitária, ou com pouco amparo, são voluntárias e dedicam parcela significativa de suas rotinas à assistência.(AU)

The present study aimed to investigate the impacts that care to an individual with Alzheimer 's can generate to the caregiver, as well as possible alternatives developed by him to deal with adversity. A integrative review was carried out on the databases “BVS Saúde”e “SciELO”, with the descriptors 'Care', 'Caregiver', 'Alzheimer'. Selected studies were available in full, free access, between the years 2015 and 2020, written in Portuguese, English and Spanish. The results found point to the existence of physical, psychological, social and financial burden on the caregiver. The common profile of the caregiver is the wife, daughters or wives of the patient, assist the patient in solitary, or with little protection, are voluntary and devote a significant portion of their routines to care.(AU)

Ultrasonographic evaluation of the fetal thymic-thoracic ratio and its association with conotruncal heart defects.

OBJECTIVE: To evaluate the thymic-thoracic ratio (TT ratio) on fetal ultrasound and its association with conotruncal heart defects. METHODS: A case control study was carried out to retrospectively assess the TT ratio on fetal echocardiograms performed between 19 and 39 weeks of gestation, showing congenital heart defects, from January to December 2018. The control group was comprised of fetuses with no echocardiogram evidence of congenital cardiac malformations. Cases of multiple pregnancies and patients where the TT ratio could not be established have been excluded. RESULTS: A total of 338 pregnancies have been analysed. Fifty-two pregnancies were diagnosed with fetal heart defects (15%), 17 of which showed conotruncal heart defects (32.7%). The TT ratio in normal fetuses (286 pregnancies) increased with gestational age, and had an average of 0.43 ± 0.06. Compared to the control group (normal fetuses), fetuses with conotruncal heart defects had significantly lower mean TT ratio (0.33 ± 0.07). Those that were diagnosed with nonconotruncal heart defects did not show any statistically significant difference in the TT ratios compared with the control group (0.40 ± 0.09 vs. 0.43 ± 0.06, respectively). CONCLUSION: The TT ratio was significantly lower in fetuses with conotruncal heart defects compared with both the control group (normal fetuses) and the fetuses with nonconotruncal heart defects.

Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in Northeastern Brazil.

OBJECTIVE: To assess the performance of a basic mid-trimester fetal ultrasound scan protocol for the diagnosis of congenital anomalies by calculating its accuracy, sensitivity, and specificity. METHODS: This longitudinal cohort study involved singleton pregnant women recruited at the mid-trimester fetal ultrasound scan through the postnatal evaluation of congenital anomalies. Pregnant women who underwent a routine mid-trimester ultrasound scan for fetal abnormalities at 20-24 weeks of gestation were enrolled in this study. After childbirth, we searched their medical records on gestational outcomes and neonatal examination records, as well as complementary medical examinations, to assess the ultrasound performance in diagnosing congenital malformations. RESULTS: We included 967 pregnant women in the study population, and prenatal ultrasound scans detected congenital abnormalities in 67 fetuses (6.9%). Among newborns, 54 (5.6%) were postnatally diagnosed with malformations. The overall sensitivity and specificity of the mid-trimester ultrasound scan for congenital malformation detection were 61.1% and 96.3%, respectively, with an accuracy of 94.3% (p < .05). CONCLUSION: The mid-trimester ultrasound scan had good accuracy in the detection of congenital malformations, although the overall sensitivity does not support it as the only screening test for anomalies throughout pregnancy.

Syncope in Patients with Cardiac Pacemakers.

INTRODUCTION: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. METHODS: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann- Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. RESULTS: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). CONCLUSION: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

Syncope in patients with cardiac pacemakers

Abstract Introduction: It is challenging to diagnose syncope in patients with pacemakers. Because these patients have increased morbidity and mortality risks, they require immediate attention to determine the causes in order to provide appropriate treatment. This study aimed to investigate the causes and predictive factors of syncope as well as the methods used to diagnose syncope in cardiac pacemaker patients. Methods: Patients with pacemakers implanted owing to sinus node disease or atrioventricular block were evaluated with standardized questionnaires, endocavitary electrograms, and other tests based on the suspected causes of syncope. Mann-Whitney U tests were used to analyze continuous variables and Chi-squared or Fisher's exact tests were used for categorical variables. Logistic regression was used for multivariate analyses. Statistical significance was P<0.05. Results: The study included 95 patients with pacemakers: 47 experienced syncope in the last 12 months and 48 did not. Of the 100 documented episodes of syncope, 48.9% were vasovagal syncopes, 17% had cardiac-related causes, 10.6% had unknown causes, and 8.5% had pacemaker failure. The multivariate analysis showed that a New York Heart Association (NYHA) Functional Class II was a significant factor for developing syncope (P<0.01). Conclusion: While the most common type of syncope in pacemaker patients was neurally mediated, it is important to perform detailed evaluations in this population as the causes of syncope can be life-threatening. The best diagnostic methods were stored electrogram analysis and the tilt table test. NYHA Functional Class II patients were found to have a higher risk for syncope.

Bark beetles in a mixed plantation of bertholletia excelsa and hevea brasiliensis in the southern Amazon / Scolytinae em plantio misto de Bertholletia excelsa e Hevea brasiliensis na amazonia meridional

Bark beetles (Curculionidae: Scolytinae) are wood borers with the potential to cause significant damage in forest plantations. Studies of this group are more common in plantations of Eucalyptus, and Pinus, but the increase of planting with other forest species, such as Brazil nut and rubber trees, indicates the need for monitoring of Scolytinae in these additional forest areas. Thus, the objective of this work was to evaluate an assemblage and the main species of bark beetles in a mixed plantation of Brazil nut trees (Bertholletia excelsa Bonpl.) and rubber trees (Hevea brasiliensis (Willd. ex A.Juss.) Müll.Arg.) in Southern Amazonia. Twelve ethanol traps were used and collections were carried out biweekly for one year. The collections were evaluated descriptively way with entomofaunistic analysis, and population fluctuation and its dispersion were determined. A total of 2,738 individuals were collected, with a total of 17 species distributed in nine genera, of which Cryptocarenus Eggers 1937 and Xyleborus Eichoff 1864 showed the greatest representation. Cryptocarenus diadematus Eggers, Cryptocarenus heveae (Hagedorni), Cryptocarenus seriatusEggers, Xyleborus affinis Eichhoff, and Xyleborus spinulosus Blandford were categorized as dominant, very abundant, very frequent, and constant. The assemblage of Scolytinae in the Brazil nut tree and rubber tree mixed plantation had a greater abundance in the rainy season, with the highest averages and population peaks. The species with the greatest representation also presented a greater number of individuals in the rainy season with aggregate dispersion.

Scolytinae são coleobrocas com potencial de causar significativos danos em plantios florestais. Estudos com este grupo são mais comuns em plantios de Eucalyptus e Pinus, mas o aumento das áreas de plantio com outras espécies florestais como castanheira e seringueira indica a necessidade demonitoramento também dos Scolytinae nestas áreas florestais. Assim, o objetivo deste trabalho foi avaliar uma assembléia e as principais espécies coletadas de escolitíneos (Curculionidae: Scolytinae) em um plantio misto de castanheira (Bertholletia excelsa Bonpl.) e seringueira (Hevea brasiliensis (Willd. ex A.Juss.) Müll.Arg.) na Amazônia Meridional, no município de Alta Floresta, Mato Grosso. As coletas foram realizadas quinzenalmente no período de agosto de 2015 a agosto de 2016, em 12 armadilhas de etanol. A assembléia foi avaliada de maneira descritiva com análises entomofaunisticas, e para as principais espécies determinou-se sua flutuação populacional e dispersão. Um total de 2.738 indivíduos foram coletados, totalizando 17 espécies distribuídas em nove gêneros, dos quais Cryptocarenus Eggers 1937 e Xyleborus Eichoff 1864foram os mais representativos. Na análise entomofaunística, Cryptocarenus diadematus Eggers, Cryptocarenus heveae(Hagedorni), Cryptocarenus seriatus Eggers, Xyleborus affinis Eichhoff e Xyleborus spinulosus Blandford foram dominantes, muito abundantes, muito frequentes e constantes. A assembléia de Scolytinae no plantio misto de castanheira com seringueira, apresentou maior abundância na estação chuvosa, com as maiores médias e picos populacionais. E as principais espécies coletadas também apresentaram maior número de indivíduos coletados na estação chuvosa com dispersão agregada.

Frugivorous butterflies from the Atlantic Forest in Southern Brazil (Lepidoptera: Nymphalidae) / Borboletas frugívoras da Mata Atlântica no Sul do Brasil (Lepidoptera: Nymphalidae)

Abstract: This study aimed to present a list of the species of frugivorous butterflies occurring in Atlantic Forests, in the Conservation Units: National Forest of Chapecó (FLONA), Ecological Station of Mata Preta (ESEC) and State Park of Araucárias (PAEAR) and adjacent forest fragments, located in the western region of the state of Santa Catarina. Three samplings were conducted between December 2017 and March 2018, totaling 24 days of collection in each sampling area. Van Someren-Rydon traps were used to capture frugivorous butterflies. There were 4,231 frugivorous butterflies belonging to four subfamilies, 12 tribes and 49 species. In all, 37 species of frugivorous butterflies were sampled in FLONA and 29 in adjacent forest fragments. In ESEC, 29 species and 33 in adjacent forest fragments. In PAEAR, 33 species and 28 in adjacent forest fragments. Of the total species registered, 15 species are new records for the state of Santa Catarina and 11 are new records for the western region of the state. The most abundant species for FLONA were: Manataria hercyna (Hübner, 1821) and Hermeuptychia sp. In ESEC, were Hermeuptychia sp. and Yphthimoides ordinaria (Freitas, Kaminski & Mielke, 2012). In PAEAR, greater abundance of Forsterinaria quantius (Godart, 1824) and Eryphanes reevesii (Doubleday, 1849) were verified. For the adjacent forest fragments to Conservation Units, there was a greater abundance of Hermeuptychia sp., Moneuptychia soter (Butler, 1877), Morpho epistrophus (Fabricius, 1796) e Forsterinaria quantius (Godart, 1824). Satyrinae presented higher richness (S = 34) and abundance (90.58%) in all areas sampled. The rarefaction and extrapolation curves for the Conservation Units and adjacent forest fragments showed a greater rise in the FLONA and PAEAR sampling units and their adjacent forest fragments. The estimated sampling coverage for Conservation Unit and forest fragments was above 97%. The richness calculated through the Jackknife 1 estimator, for the FLONA and PAEAR samplings, presented a value of 50.75 and 37.09, respectively. The fauna of frugivorous butterflies from this region, first investigated in areas of Conservation Units, showed to be expressive and well represented in the Atlantic Forest Biome, indicating its potential as a refuge for biodiversity.

Resumo: O estudo teve como objetivo elaborar uma lista das espécies de borboletas frugívoras ocorrentes em florestas da Mata Atlântica, nas Unidades de Conservação: Floresta Nacional de Chapecó (FLONA), Estação Ecológica da Mata Preta (ESEC) e Parque Estadual das Araucárias (PAEAR) e fragmentos florestais adjacentes, localizados na Região Oeste de Santa Catarina. Foram realizadas três campanhas de coletas entre dezembro de 2017 e março de 2018, totalizando 24 dias de coletas em cada área amostral. Para a captura das borboletas frugívoras, foram utilizadas armadilhas Van Someren-Rydon. Foram registradas 4231 borboletas frugívoras pertencentes a quatro subfamílias, 12 tribos e 49 espécies. Foram amostradas 37 espécies de borboletas frugívoras na FLONA e 29 nos fragmentos florestais adjacentes. Na ESEC 29 espécies e 33 nos fragmentos florestais adjacentes. No PAEAR 33 espécies e 28 nos fragmentos florestais adjacentes. Do total de espécies registradas, 15 espécies de borboletas frugívoras são novos registros para o estado de Santa Catarina e 11 são novos registros para a região oeste do estado. As espécies mais abundantes para a FLONA foram: Manataria hercyna (Hübner, 1821) e Hermeuptychia sp. Na ESEC, foram Hermeuptychia sp. e Yphthimoides ordinaria (Freitas, Kaminski & Mielke, 2012). No PAEAR verificou-se maior abundância das espécies Forsterinaria quantius (Godart, 1824) e Eryphanes reevesii (Doubleday, 1849). Para os fragmentos florestais adjacentes das Unidades de Conservação houve maior abundância das espécies: Hermeuptychia sp., Moneuptychia soter (Butler, 1877), Morpho epistrophus (Fabricius, 1796) e Forsterinaria quantius (Godart, 1824). Satyrinae apresentou maior riqueza (S=34) e abundância (90,58%) de borboletas frugívoras em todas as áreas amostradas. As curvas de rarefação e extrapolação, para as Unidades de Conservação e fragmentos florestais adjacentes mostraram uma maior ascendência nas unidades amostrais da FLONA e PAEAR e seus fragmentos florestais adjacentes. A cobertura estimada de amostragem para as borboletas frugívoras, para as Unidades de Conservação e fragmentos florestais, ficou acima de 97%. A riqueza calculada através do estimador Jackknife 1, mostrou-se superior à riqueza observada, sendo que para as amostragens na FLONA e PAEAR, o estimador apresentou um valor de 50,75 e 37,09, respectivamente. A fauna de borboletas frugívoras da região, investigada pela primeira vez em áreas de Unidades de Conservação, mostrou-se bastante expressiva e bem representada no Bioma Mata Atlântica, indicando seu potencial como refúgio da biodiversidade.

Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients / Evolução Clínica Pós-Implante de Desfibrilador Cardíaco: Pacientes Chagásicos Versus Isquêmicos

Abstract Background: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial. Objective: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). Methods: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared. Results: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups. Conclusion: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients.

Resumo Fundamento: A evolução do paciente chagásico após implante de cardiodesfibrilador implantável (CDI) é tema ainda controverso. Objetivo: Comparar a evolução clínica pós-implante do CDI em pacientes com cardiopatia chagásica crônica (CCC) e cardiopatia isquêmica (CI). Métodos: Trata-se de um estudo prospectivo histórico de uma população de 153 pacientes portadores de CDI, sendo 65 com CCC e 88 com CI. Os dispositivos foram implantados entre janeiro de 2003 e novembro de 2011, tendo-se comparado a taxa de sobrevida e a sobrevida livre de eventos entre essas populações. Resultados: Os grupos foram similares na predominância do sexo masculino, classe funcional e fração de ejeção. Os pacientes isquêmicos são em média 10 anos mais velhos que os chagásicos (p < 0,05). Os pacientes chagásicos apresentavam escolaridade e renda mensal mais baixa do que os isquêmicos (p < 0,05). Foi demonstrado que o número de terapias apropriadas nos pacientes com CCC é 2,07 vezes maior do que naqueles com CI. A incidência de choque apropriado é maior na CCC (p < 0,05). As taxas de mortalidade anual nos dois grupos foram similares, assim como a incidência de tempestade elétrica. Não houve nenhuma morte súbita nos pacientes com CCC e apenas uma nos pacientes com CI. Não houve diferença estatisticamente significativa no tempo de sobrevida entre os dois grupos (p = 0,720) nem na sobrevida livre de eventos (p = 0,143). Conclusão: A CCC duplica o risco de receber terapias apropriadas em relação à CI, mostrando assim maior complexidade das arritmias nos pacientes chagásicos.

Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients.

BACKGROUND: The outcome of Chagas disease patients after receiving implantable cardioverter defibrillator (ICD) is still controversial. OBJECTIVE: To compare clinical outcomes after ICD implantation in patients with chronic Chagas cardiomyopathy (CCC) and ischemic heart disease (IHD). METHODS: Prospective study of a population of 153 patients receiving ICD (65 with CCC and 88 with IHD). The devices were implanted between 2003 and 2011. Survival rates and event-free survival were compared. RESULTS: The groups were similar regarding sex, functional class and ejection fraction. Ischemic patients were, on average, 10 years older than CCC patients (p < 0.05). Patients with CCC had lower schooling and monthly income than IHD patients (p < 0.05). The number of appropriate therapies was 2.07 higher in CCC patients, who had a greater incidence of appropriate shock (p < 0.05). Annual mortality rate and electrical storm incidence were similar in both groups. There was no sudden death in CCC patients, and only one in IHD patients. Neither survival time (p = 0.720) nor event-free survival (p = 0.143) significantly differed between the groups. CONCLUSION: CCC doubles the risk of receiving appropriate therapies as compared to IHD, showing the greater complexity of arrhythmias in Chagas patients.

Preditores de mortalidade em pacientes com cardiopatia isquêmica e cardiopatia chagásica crônica com cardiodesfibrilador implantável / Predictors of mortality in ischemic heart disease and Chagas disease patients with implantable cardioverter-defibrillator

Introdução: A cardiopatia chagásica crônica e a cardiopatia isquêmica são duas das principais causas de insuficiência cardíaca crônica na América Latina e também são relacionadas a morte súbita cardíaca, sendo, portanto, indicações comuns para o uso de cardiodesfibriladores implantáveis. Este estudo teve como objetivo avaliar preditores de mortalidade em pacientes com cardiopatia chagásica crônica e cardiopatia isquêmica com cardiodesfibrilador implantável. Método: Estudo prospectivo histórico que incluiu 153 pacientes (65 portadores de cardiopatia chagásica crônica e 88 portadores de cardiopatia isquêmica), acompanhados entre 2003 e 2011 no Hospital Universitário Walter Cantídio por um tempo médio de 32 (14,7-55) meses. Foram realizadas análises de degressão de Cox uni e multivariada além de teste de proporcionalidade de Schoenfeld e dos resíduos Cox-Snell. Resultados: Os grupos foram similares quanto a sexo, classe funcional e fração de ejeção. Quando analisados em conjunto, idade > 60 anos e classe funcional IV foram fatores de maior mortalidade. No grupo com cardiopatia chagásica crônica, baixa escolaridade e fração de ejeção < 30% aumentaram a chance de morte; já no grupo com cardiopatia isquêmica, apenas a idade aumentou a chance de morte. Os pacientes chagásicos apresentaram escolaridade e renda mensal inferiores, comparativamente aos isquêmicos. Conclusão: Idade > 60 anos e classe funcional IV foram preditores de pior evolução no subgrupo de pacientes portadores de cardiodesfibrilador implantável com cardiopatia chagásica crônica e cardiopatia isquêmica.

Background: Chronic Chagas disease and ischemic heart disease are two of the main causes of chronic heart failure in Latin America and are also related to sudden cardiac death and have, therefore, common indications for the use of implantable cardioverter-defibrillators. The objective of this study was to measure mortality predictors in patients with Chagas disease and ischemic heart disease with an implantable cardioverter-defibrillator. Method: A prospective study including 153 patients, 65 with Chagas disease and 88 with ischemic heart disease, between 2003-2011 at Hospital Universitário Walter Cantídio. The follow-up was a median of 32 (14.7 to 55) months. Cox regression univariate and multivariate analyzes were performed in addition to Schoenfeld and Cox-Snell residuals to test proportional hazards. Results: The groups were similar for gender, functional class and ejection fraction. When analyzed in combination, age > 60 years and functional class IV were predictors for higher mortality. In the group with chronic Chagas disease, low education levels and ejection fraction < 30% increase in the probability of death; whereas in the group with ischemic heart disease, only age increased the probability of death. Chagasic patients had lower educational levels and monthly incomes when compared to ischemic patients. Conclusion: Age > 60 years and functional class IV were predictors of poor outcomes in the subgroup of patients with implantable cardioverter-defibrillator with chronic Chagas disease and ischemic heart disease.

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina / Perfil de erros de administração de medicamentos em anestesia entre anestesiologistas catarinenses

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

INTRODUÇÃO: A anestesiologia é a única especialidade médica que prescreve, dilui e administra os fármacos sem conferência de outro profissional. Somando-se a alta frequência de administração de fármacos, cria-se o cenário propício aos erros. OBJETIVO: Verificar a prevalência dos erros de administração de medicamentos durante anestesia, entre anestesiologistas catarinenses, as circunstâncias em que ocorreram e possíveis fatores associados. MATERIAIS E MÉTODOS: Um questionário eletrônico foi enviado a todos os anestesiologistas da Sociedade de Anestesiologia do Estado de Santa Catarina contendo respostas diretas ou de múltipla escolha sobre dados demográficos e perfil da prática anestésica do entrevistado; prevalência de erros, tipo e consequência do erro; e fatores que possivelmente contribuíram para os erros. RESULTADOS: Dos entrevistados, 91,8% afirmaram ter cometido erro de administração, somando total de erros de 274 e média de 4,7 (6,9) erros por entrevistado. O erro mais comum foi substituição (68,4%), seguido por erro de dose (49,1%) e omissão (35%). Apenas 7% dos entrevistados referiram erros de administração no neuroeixo. Quanto às circunstâncias dos erros, ocorreram principalmente no período matutino (32,7%), na manutenção da anestesia (49%), com 47,8% sem danos ao paciente e 1,75% com maior morbidade com dano irreversível e em 87,3% dos casos a identificação imediata. Quanto aos possíveis fatores contribuintes, os mais frequentes foram: distração e fadiga (64,9%) e leitura errada dos rótulos de ampolas ou seringas (54,4%). CONCLUSÃO: A maioria dos anestesiologistas entrevistados cometeu mais de um erro de administração em anestesia, principalmente justificado como distração ou fadiga, de baixa gravidade.

Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina.

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

[Profile of drug administration errors in anesthesia among anesthesiologists from Santa Catarina]. / Perfil de erros de administração de medicamentos em anestesia entre anestesiologistas catarinenses.

INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors. RESULTS: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were: distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%). CONCLUSION: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity.

Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy / Parâmetros Ecocardiográficos Preditores de Pior Evolução após a Terapia de Ressincronização Cardíaca

Abstract Background: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. Objective: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. Method: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre‑implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. Results: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6‑12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. Conclusion: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Resumo Fundamento: A terapia de ressincronização cardíaca (TRC) é um tratamento recomendado pelas principais diretrizes mundiais. Entretanto, 30%-40% dos pacientes selecionados não respondem ao tratamento. Objetivo: Elaborar um modelo ecocardiográfico preditor de risco de óbito cardíaco ou transplante (Tx) após 1 ano da TRC. Método: Estudo observacional, prospectivo, com inclusão de 116 pacientes, sendo 69,8% do sexo masculino, com idade de 64,89 ± 11,18 anos, CF III (68,1%) e IV ambulatorial (31,9%), bloqueio de ramo esquerdo em 71,55%, e mediana da fração de ejeção (FE) de 29%. Avaliações foram feitas no período pré-implante e 6-12 meses após, e correlacionadas com mortalidade cardíaca/Tx no final do seguimento. Foram realizadas análises de regressão de Cox e logística, com a curva ROC e de sobrevida de Kaplan-Meier. O modelo foi validado internamente pelo “bootstrapping”. Resultados: Ocorreram 29 (25%) óbitos/Tx durante o seguimento de 34,09 ± 17,9 meses. A mortalidade cardíaca/Tx foi de 16,3 %. No modelo multivariado de Cox, as variáveis FE < 30%, disfunção diastólica grau III/IV e regurgitação mitral grau III, aferidas com 6-12 meses, relacionaram-se independentemente a aumento de mortalidade cardíaca ou Tx, com razões de risco de 3,1, 4,63 e 7,11, respectivamente. A área sob a curva ROC foi de 0,78. Conclusão: FE menor que 30%, disfunção diastólica grave e regurgitação mitral severa indicam pior prognóstico após 1 ano da TRC, devendo ser consideradas outras opções terapêuticas na presença da combinação de duas dessas variáveis.

Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy.

BACKGROUND: 30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes. OBJECTIVE: This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT). METHODS: Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves. RESULTS: The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping. CONCLUSION: We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy / Desenvolvimento e Validação de Modelos Preditores de Mortalidade Cardíaca e Transplante na Terapia de Ressincronização Cardíaca

AbstractBackground:30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes.Objective:This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT).Methods:Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves.Results:The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping.Conclusion:We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT.

ResumoFundamento:A terapia de ressincronização cardíaca pode demonstrar resultados desfavoráveis em 30-40% dos casos.Objetivo:Este estudo teve por objetivo desenvolver modelos preditores para o desfecho combinado de morte cardíaca ou transplante (Tx) em diferentes estágios da terapia de ressincronização cardíaca (TRC).Métodos:Estudo prospectivo observacional de 116 pacientes com idade média de 64,8 ± 11,1 anos, dos quais 68,1% estavam em classe funcional (CF) III e 31,9% em classe IV ambulatorial. Variáveis clínicas, eletrocardiográficas e ecocardiográficas foram avaliadas com regressão de Cox e curvas de Kaplan-Meier.Resultados:O desfecho mortalidade/Tx cardíacos foi de 16,3% durante seguimento de 34,0 ± 17,9 meses. No período pré-implante, disfunção ventricular direita (DVD), fração de ejeção < 25% e uso de altas doses de diuréticos (ADD) aumentaram o risco de morte e Tx cardíacos em 3,9, 4,8 e 5,9 vezes, respectivamente. No primeiro ano após TRC, DVD, AHDD e hospitalização por insuficiência cardíaca congestiva elevaram o risco de morte (razões de risco de 3,5, 5,3 e 12,5, respectivamente). No segundo ano após TRC, DVD e CF III/IV foram fatores de risco significativos de mortalidade no modelo multivariado de Cox. As acurácias dos modelos foram 84,6% na pré-implante, 93% no primeiro ano após TRC e 90,5% no segundo ano após TRC. Os modelos foram validados por bootstrapping.Conclusão:Desenvolvemos modelos preditores de morte e Tx cardíacos em diferentes estágios de TRC com base na análise de variáveis clínicas e ecocardiográficas simples e de fácil obtenção. Os modelos mostraram boa acurácia e ajuste, foram validados internamente e são úteis para a seleção, o monitoramento e a orientação de pacientes indicados para TRC.

Echocardiographic Predictors of Worse Outcome After Cardiac Resynchronization Therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is the recommended treatment by leading global guidelines. However, 30%-40% of selected patients are non-responders. OBJECTIVE: To develop an echocardiographic model to predict cardiac death or transplantation (Tx) 1 year after CRT. METHOD: Observational, prospective study, with the inclusion of 116 patients, aged 64.89 ± 11.18 years, 69.8% male, 68,1% in NYHA FC III and 31,9% in FC IV, 71.55% with left bundle-branch block, and median ejection fraction (EF) of 29%. Evaluations were made in the pre­implantation period and 6-12 months after that, and correlated with cardiac mortality/Tx at the end of follow-up. Cox and logistic regression analyses were performed with ROC and Kaplan-Meier curves. The model was internally validated by bootstrapping. RESULTS: There were 29 (25%) deaths/Tx during follow-up of 34.09 ± 17.9 months. Cardiac mortality/Tx was 16.3%. In the multivariate Cox model, EF < 30%, grade III/IV diastolic dysfunction and grade III mitral regurgitation at 6­12 months were independently related to increased cardiac mortality or Tx, with hazard ratios of 3.1, 4.63 and 7.11, respectively. The area under the ROC curve was 0.78. CONCLUSION: EF lower than 30%, severe diastolic dysfunction and severe mitral regurgitation indicate poor prognosis 1 year after CRT. The combination of two of those variables indicate the need for other treatment options.

Long-term follow-up of patients with chronic chagas disease and implantable cardioverter-defibrillator.

BACKGROUND/OBJECTIVES: Chronic Chagas heart disease (ChHD) is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Little is known about the effectiveness of implantable cardioverter-defibrillator (ICD) therapy in this population. The objective of this study was to evaluate the efficacy of ICD in patients with ChHD and to identify predictors of mortality and appropriate ICD shocks. METHODS: The cohort study included 65 patients with ChHD and ICD for primary and secondary prevention of sudden death. The Cox model was applied to evaluate the predictors of mortality, and survival was assessed by Kaplan-Meier analysis. RESULTS: The median age was 56 ± 11.9 years. The median follow-up was 40 ± 26.8 months. Among the patients 23 (36.5%) had appropriate shocks. A total of 13 (20%) patients died (6.1% of annual mortality rate), and there was no sudden death. In univariate Cox model, functional class IV (hazard ratio [HR] = 1.99; 95% confidence interval [CI], 1.05-3.76; P = 0.034), primary prevention (HR = 0.29; 95% CI, 0.09-0.99; P = 0.048), lower education (HR = 2.51; 95% CI, 1.05-5.99; P = 0.038), and ejection fraction <30% (HR = 2.80; 95% CI, 1.09-7.18; P = 0.032) were predictors of worse prognosis (death). In the multivariate Cox model, an ejection fraction <30% and the low education remained predictors of poor prognosis. Predictors of appropriate shocks were not found. CONCLUSIONS: The ICD was effective for the prevention of sudden cardiac death in patients with chronic ChHD. An ejection fraction <30% and low education were predictors of poor prognosis.